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Avascular necrosis is
bone death that occurs when the blood supply to the bones is decreased or
stopped. Without an adequate blood supply, the bone breaks down and dies and
collapses. If the bone affected is near a joint, the joint may also collapse.
Although any bone can be affected, avascular necrosis most often affects ends
of the long bones, such as the upper leg bone at the hip.
Avascular necrosis is also called osteonecrosis, aseptic necrosis, or
ischemic bone necrosis.
An injury, such as a
forceful impact in an auto accident, or a complication of a hip fracture or
dislocation can lead to avascular necrosis. Diseases such as
sickle cell disease,
lupus also may lead to avascular necrosis.
Long-term use of
corticosteroids or drinking a large amount of alcohol
over a long time increases the risk of avascular necrosis.
Symptoms include mild to
moderate hip or groin pain, decreased hip movement, and a limp. Pain may be
sudden and become worse with standing or walking. Rest usually relieves the
pain. Avascular necrosis occurs most often in men between 40 and 50 years old.
Children with avascular necrosis may have spasms in the hip
muscle, have a limp, or refuse to bear weight.
Legg-Calve-Perthes disease is a type of avascular
necrosis in children that causes hip symptoms.
Doctors usually start with
treatments to limit further damage to the bone and joint and to help the bone
to grow. Treatments may include medicines, exercises, and electrical stimulation as well as limiting weight-bearing on the
joint. Anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain. Eventually,
most people with avascular necrosis need surgery.
May 7, 2013
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
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